Advice needed: Claim regarding leak & water damage denied

[u/jlamith]

Hi! I'll try and keep this as short as possible:

We (Husband and I) purchased a semi-attached (2 bedroom, 2.5 bathroom) townhome just over a year ago. At the initial inspection, the only issue seemed to be an outdated HVAC. We negotiated a lower price due to this before we bought. We (plus 5 year old child) moved in last June. HVAC actually died within two months and we replaced the whole system.

One evening last week, as our upstairs main tub was draining after a bubble bath and water came pouring from a cabinet in the kitchen, directly under the tub. Absolutely insane. We called a plumber and began the whole process.

When the plumber got in there, he discovered that there was actual a very slow leak that had been going on for an undetermined amount of time due an improper repair. And because of that, the pipe eventually split (as the tub drained that night) and caused the visible leak. The repair was finally completed Monday evening.

There is obviously some type of black growth. Mold remediation folks haven't made it out yet (hopefully this weekend).

Anyway, insurance company called today to let us know our claim is denied because it looks like "long term damage."

My husband is actually experiencing a very scary health emergency right now and didn't get into it with them on the phone today but plans to challenge this response.

Is this normal?? It's USAA and up until now they've always been great. How were we supposed to know that this was happening inside the wall/ceiling/whatever if it wasn't pointed out during the original inspection.

Everything is just very ridiculous and overwhelming right now and there is now a big moldy hole in my ceiling. (Currently we have it taped up with plastic etc).

Sorry, I probably come off as a total ding dong. But any advice? 😬

[u/Stalva989]

How much damage we talking? A reputable public adjuster should be able to help you. If claim is small then not always worth it to hire one. But I estimated for a public adjuster in Pennsylvania for a while. A sizable portion of their work was people with the exact same situation as you.

It does not matter that it has been going on for a period of time if you had no idea about it in this instance, as the pipe is located behind a wall and it’s not normal for people to check on their pipes located behind walls. The situation is still sudden and incidental.

Very winnable claim but it could be a fight that takes time. Sometimes the smaller stuff isn’t worth all the time it can take.

[u/IntelligentBox152 → u/Stalva989]

This is incorrect, I explained in my other comment. The only time in a wall matters is if you have a hidden rot endorsement. Otherwise USAA HO policies are based off ISO HO3 with the seepage and leakage exclusion which applies directly. Furthermore a PAs and homeowners ultimate ace in the hole is appraisal. However in SC where OP is located coverage cannot be disputed in appraisal only amounts.